NY Times Story on SmallPox Threat.

In 1520, Hernando Cortes, the Spanish conqueror of Mexico, is believed to have unintentionally brought a smallpox-infected slave with him to the New World. In the next two years, an estimated 3.5 million Aztecs died.

----Excerpt from article.

Dear Polly Friends,

I'm sure you must be right in saying that we have nothing to worry about Y2K. And this smallpox thing is probably a lot of bunk, too. We all know that the Serbs, Chinese, Russians, Libyans, Iraquis, North Koreans, OM Shin Rikio (sp) and others who might be capable of unleashing something like this are would realize that its too risky and might come back to infect them too.

Just ask your Aztec friends.

-------Alexi

http://www.nytimes.com/library/national/science/061599sci-smallpox.html

Smallpox: The Once and Future Scourge?

June 15, 1999

The following article was reported by Lawrence K. Altman, William J. Broad and Judith Miller and was written by Broad.

No one has come down with smallpox for decades. But in some respects it is potentially more dangerous than ever.

Smallpox killed more people over the ages than any other infectious disease. In the 20th century alone, experts estimate, it took up to a half billion lives, more than all the wars and epidemics put together.

Its scars run deep. As long as three thousand years ago, Chinese records tell of slow deaths and disfigurations. Signs of pockmarks appear on the mummified head of the Egyptian Pharaoh Ramses V. The disease decimated Europe and traveled with colonists to the New World, laying waste to tribes and aiding British soldiers who spread the virus as a biological weapon.

Today, the high fevers, deep rashes and oozing pustules that characterize smallpox are gone -- a feat of disease eradication so far unequaled in the history of public health. This banishment is so complete that recent medical textbooks often skip the disease or give few details of its wrath.

Despite this triumph of modern medicine, Washington and key allies now fear the scourge could strike anew sometime in the future, unleashed by war or terrorism. And that worry is raising new alarms and questions.

What makes the virus so deadly? How well do old vaccinations work? What about new drugs and vaccines? How likely is a smallpox attack?

Some answers are grim. For instance, troubles with quality control are such that no stored smallpox vaccine in the United States can now be used except in emergencies, Federal officials say. Stoppers on vials are deteriorating and a vital ancillary medicine is unusable.

A turning point came on April 22 when the United States -- one of two official smallpox repositories around the globe, along with Russia -- announced that it would delay its intended destruction of the virus, reversing years of planning and Washington's previous stance.

The virus was to have been destroyed this month, the first species driven to extinction by design rather than accident. But the Clinton Administration, after careful study, concluded that clandestine supplies probably exist and could cause the disease to emerge suddenly in war. And it reasoned that living samples might aid the development of new treatments and antidotes. In the wake of that decision, a host of other actions are now taking shape.

Most visibly, top scientists and health experts are now calling for a Federal program to produce new vaccine to protect up to 100 million people in the United States -- enough, in theory, to stop any epidemic in its tracks. More quietly, American and Russian scientists hope to embark on studies to better understand the killer's ways in an effort to perfect a cure. And most stealthily of all, intelligence agencies are stepping up their efforts to better judge the threat of smallpox attacks.

"It's disturbing, extremely disturbing," said Dr. Donald A. Henderson, the scientist who led the global campaign that eradicated smallpox and now is dean emeritus of the Johns Hopkins School of Public Health. "I thought the door had closed on smallpox. I had happily put it away."

Dr. Joshua Lederberg, a Nobel laureate in biology who advises Washington on germ warfare, called the eradication "one of the great humanitarian accomplishments of our century." But he added: "We have no idea what may have been retained, maliciously or inadvertently, in the laboratories of a hundred countries from the time that smallpox was a common disease. These would be the most likely sources of supply for possible bioterrorists."

To the extent that past is prologue, the experts say, the history of smallpox offers clues to the dangers and opportunities that may lie ahead.

Experts warn that if smallpox returns it could be more deadly than ever. The effects of the disease on an unprotected population were underscored by the experience of settlers who set sail from Plymouth, England, landed on the Massachusetts coast in 1620 and found the area remarkably free of Indians because a deadly epidemic had just swept through. Early explorers had already spread the virus.

Over the ages, immunities built up slowly as people survived the infection, with children usually faring better than adults. Later on, vaccinations helped keep the scourge at bay.

Today, experts say, such protections are all but gone and people are generally more vulnerable to the disease, underscoring the need for intelligent debate and possibly protective action.

"We're all Indians," said Elizabeth A. Fenn, a smallpox historian at George Washington University. "We're approaching 100 percent susceptibility."

THE MURDERER

As Viruses Go, Huge and Vicious

o one knows where smallpox came from. Viral historians say it probably began as an epidemic disease 10,000 years ago when human populations first grew dense. The virus is unusual in that it inhabits only humans, unlike many whose main home is in animals.

"It had to have evolved from its natural forebears," said Dr. Lederberg, a president emeritus of Rockefeller University. "Close relatives like monkeypox are still fairly prevalent in the rain forests, occasionally reaching humans."

Evidence that the disease has existed for at least three millennia is found in the scars on the head and shoulders of the Pharaoh Ramses V, who died as a young man in 1157 B.C., perhaps of the disease. Deities in India and West Africa are devoted to smallpox, attesting to ages of devastation.

The disease, probably spread by traders, is said by historians to have reached Europe sometime in the first millennium.

In 1520, Hernando Cortes, the Spanish conqueror of Mexico, is believed to have unintentionally brought a smallpox-infected slave with him to the New World. In the next two years, an estimated 3.5 million Aztecs died.

In 18th-century Europe, smallpox killed 400,000 people a year, peasants and monarchs alike, a toll proportionately equivalent to more than a million deaths today. The disease in one 80-year period is said to have taken the lives of a Queen of England, an Emperor of Austria, a King of Spain, a Czar of Russia, a King of France and a Queen of Sweden. And President Abraham Lincoln in 1863 was probably feverish with the disease when he gave the Gettysburg Address. Two days later, he broke out in the gruesome rash.

Modern science has found that the smallpox virus, known as variola, is a monster in size, possessing one of the largest genetic blueprints of any virus. Whether that helps explain its extraordinary lethality is unknown. What is clear is that, unlike most viruses, it is highly stable outside its host and can retain its powers of infection over long periods of time, aiding its spread among victims.

After a person is exposed, the virus multiplies rapidly and spreads unobtrusively through the body's lymph system for about two weeks. Suddenly the symptoms come on. The head, back and muscles ache. The temperature spikes as high as 104 degrees, leaving the victim drained. In these hours, little distinguishes smallpox from garden-variety flu.

In about two days, fever and aches give way to pockmarks. At first they dot the tongue and roof of the mouth and then, over a few days, break out over the face and spread to the arms and legs. Flat and red at first, the pox over two weeks or so turn into small blisters and fill with pus, after which scabs form. Sometimes the entire rash becomes bloody.

In its early stages, the disease is often confused with chicken pox, and one way to distinguish them is that the smallpox rash often spreads farther, covering the palms and soles.

About a third of the victims die, mainly from blood loss, low blood pressure, cardiovascular collapse and secondary infections. Many survivors are scarred and blinded. Others have shortened bones and other complications.

Smallpox spreads easily once the rash appears in the throat or skin, and studies have shown that each infected person typically passes the virus to three or four others in close contact, often by coughing. In hospitals, the virus has been shown to travel surprisingly far in the air.

THE ERADICATION

Hunting Down an Assassin

n 18th-century Europe, one segment of the population -- milkmaids -- attracted medical attention because they escaped smallpox. Surmising that these workers may have developed an immunity from their association with cows, who were prone to a related disease, cowpox, Edward Jenner, a British physician, in 1796 vaccinated a boy with material from an infected cow, Blossom.

Two months later, Jenner inoculated the boy with smallpox virus, but the boy did not get sick. He was immune. Jenner had successfully developed the smallpox vaccine. Jenner sent his report on this breakthrough to the Royal Society, which promptly rejected it. So Jenner published the historic paper on his own.

Like any vaccine, Jenner's worked by alerting the body's immune system to the threat of microscopic invaders, prompting the formation of antibodies to fight them off. The novelty was that Jenner used one virus to protect against another, the first being similar enough to trigger the body's defenses. Cowpox protected against smallpox even though the two viruses, though clearly related, are distinct species.

Jenner dreamed of eliminating smallpox. But no serious efforts were made until the 20th century. As late as the 1930's, smallpox struck up to 50,000 people each year in the United States. The last case occurred in 1949 in Hidalgo County, Texas. Although Jenner had used cowpox virus, a third virus, vaccinia, became the standard vaccine against smallpox. Experts say vaccinia is related to the smallpox and cowpox viruses, but its origin is a major scientific mystery.

Global vaccinations and quarantines began to be envisioned when, after World War II, the World Health Organization was founded as an arm of the newly established United Nations.

In 1959, W.H.O. resolved to eradicate smallpox, largely at Moscow's urging. But little happened until 1966, when the United States and the Soviet Union proposed $2.5 million for an expanded effort. That year two million people died of the disease, mainly in Bangladesh, Brazil, India, Indonesia, Nepal, Pakistan and African countries south of the Sahara.

Mass vaccinations were not enough to stop all viral transmission. So planners added strong measures to hunt down hidden cases and quarantine victims in an effort to create transmission barriers.

In many countries, tribal healers were hired to perform vaccinations, eventually doing much good. "They were soon out of a job," recalled Dr. Henderson, who led the global campaign.

Europe wiped out smallpox early on. But infected foreign visitors still caused outbreaks so severe that hospitals specifically for smallpox were built. As late as the 1960's, West Germany constructed two such hospitals.

India was one of the last major hurdles. In 1975 during a two-week period, 130,000 workers visited 100 million homes there, finding many smallpox cases. Cash rewards produced others. With each sweep, the smallpox count dropped.

Once India was free of the disease, attention turned to Ethiopia. Counts fell and the global effort seemed over. But then cases popped up in Somalia, on the horn of Africa. After another push, W.H.O. recorded the last case on Oct. 26, 1977, putting the Somali victim in quarantine.

With that, the person-to-person chain was broken, defeating the scourge.

In 1980, W.H.O. proclaimed the world free of smallpox and soon asked for all laboratory samples of the virus to be destroyed or sent to central repositories. But it had no inspection powers. The heroes of the eradication effort had to take nations of the world on their word when, one by one, they said the dreaded virus was gone.

THE THREAT

Dark Evidence of Hidden Arsenal

The deadliness of smallpox has long beckoned to military minds and was exploited in the New World with relative ease. Settlers and soldiers from Europe often had immunity because of childhood exposure. And Indians did not. So the virus tended to kill selectively, overcoming a general drawback of germ weapons.

During an Indian uprising in 1763, Sir Jeffery Amherst, commander of British forces in North America (and namesake of the Massachusetts city), suggested that the disease be sown deliberately. "Could it not be contrived to send the Small Pox among those disaffected tribes of Indians?" he wrote a subordinate, encouraging the use of "every stratagem in our power to reduce them."

In fact, his men at Fort Pitt, today Pittsburgh, had already forged ahead without his encouragement, giving Indians infected blankets and a germ-laden handkerchief. Epidemics ensued, but historians are unsure to what extent the spread was due to natural or deliberate exposure.

Dr. Fenn, the George Washington historian, who is finishing a book on smallpox epidemics in America, said Amherst and his men's independent pursuit of smallpox weapons showed the idea's prevalence and wide appeal, which continued into the Revolutionary War.

"They were willing to use it in nasty ways," she said of British forces. "But it's almost impossible to determine how effective it was."

Still, she said, George Washington was suspicious enough of the British using smallpox as a weapon, and had lost so many troops to the disease, that in 1777 he ordered his men to undergo crude inoculations. The Americans, in contrast to English soldiers, had typically grown up without exposure to the disease. Thus, like the Indians, they had no acquired immunity.

Despite its apparent disuse in the last two centuries, the idea of smallpox as a weapon has never disappeared. Indeed, evidence has recently surfaced that many such armaments were made, if not used.

In 1992, a Soviet official named Kanatjan Kalibekov, now known as Ken Alibek, defected to the United States.

In secret debriefings, Alibek, formerly a top player in Soviet germ warfare, told Washington that Moscow had made tons of smallpox for war, and he suggested that the virus might have been sold or secreted away as the Soviet state collapsed and Russian scientists sought new ways to support themselves.

Last year he went public, and he followed this year with a book, "Biohazard" (Random House), which details a nightmare of smallpox weapons that he says the Soviet Union made, including warheads for long-range missiles.

W.H.O.'s announcement of the disease's eradication in 1980, Alibek wrote, had prompted the Soviets to redouble their smallpox efforts. "Where other governments saw a medical victory," he said, "the Kremlin perceived a military opportunity."

Federal officials say they have confirmed many of Alibek's smallpox claims and have also found signs that the virus is now hidden in Iraq and North Korea, although they report seeing no evidence of smallpox arms or planned strikes. The intelligence, they say, helped drive Clinton's April 22 decision to forgo destruction of American stocks.

Officially, destruction of the virus has been put off three years, until at least June 2002, as world health authorities debate the stay.

THE VACCINE

Nagging Doubts About a Life Saver

n 1972, the United States stopped routine vaccinations of civilians against smallpox, nearly a decade ahead of much of the world. Thus, about 114 million Americans born since then, 42 percent of the population, are completely vulnerable.

For people age 27 and older who were vaccinated, the degree of protection is unclear because scientists have never systematically measured the duration of immunity. Protection probably drops with time, but how much is unknown. Lifelong immunity is unlikely, some experts say. But old vaccinations may lead to milder attacks.

At the end of the eradication program, W.H.O. and a number of countries independently stored enough smallpox vaccine for 60 million people and kept a safeguarded supply of the vaccinia virus to make vaccine in case more was needed.

With its cache, the United States in theory could protect up to 14 million people if each vial of stored vaccine was used to its maximum potential of 100 doses. The manufacturer, Wyeth Laboratories, holds the supply of vaccine in Marietta, Pa., under the control of the Centers for Disease Control and Prevention in Atlanta.

Smallpox vaccine is still needed at C.D.C. for scientists who work with the virus. But serious problems with quality control have stopped vaccinations, creating an acute problem for a very select group of scientists in the United States and, in the event of an emergency, a much wider group of people.

Crumbling rubber stoppers on vials are letting in moisture, and a brilliant green dye is inexplicably losing its color, but the vaccine remains near normal potency, Federal experts say. The bigger problem is that the American supply of a colorless liquid medicine, known as vaccinia immune globulin, which is needed to counteract adverse reactions to the vaccine, has turned pink for reasons no one understands. Federal rules say the medicine must be on hand before vaccinations are given, and the Food and Drug Administration has barred its use until the mystery is solved.

A further complication is that new batches of vaccine cannot be made with the old process, since today that process would fail to pass the F.D.A.'s more rigorous standards.

In late 1997, prompted in part by Alibek's revelations, the Pentagon embarked on a $322 million program to make new vaccines for the military, including smallpox. The earliest it will be ready, officials say, is 2005 -- if it can pass F.D.A. muster. That will be difficult. Because the disease no longer exists and the virus is too lethal to unleash on people, clinical trials cannot be conducted to test whether or not the new vaccine actually helps humans resist smallpox.

"Ultimately, they're going to have to make a fairly substantial judgment call," Steve Pryor, president of Dynport, the Pentagon's vaccine contractor, said of F.D.A. officials.

Civil authorities in Washington want at least 40 million doses of new smallpox vaccine, and health experts like Dr. Henderson, who now heads a center for the study of bioterrorism at Johns Hopkins, are calling for 100 million. Talks are under way for Dynport to produce vaccine for civilian use as well, but nothing to date has been worked out.

Meanwhile, some experts question the whole vaccine approach as a germ warfare safeguard. Foes, they say, knowing well in advance about vaccinations, might counter them by switching to a different germ or a different variant, perhaps genetically engineered.

"Defensive measures are much more difficult than offensive ones," said William C. Patrick 3d, who made germ weapons for the United States before President Nixon outlawed them three decades ago.

Such threats are helping fuel a search for new ways to combat smallpox and related viruses, including the development of new kinds of anti-viral drugs. Unlike vaccines, such drugs, if found workable, might be administered long after exposure to save infected victims, attacking the virus directly rather than relying on the body's immune defenses.

In March, the National Academy of Sciences released a 108-page report listing new research frontiers, many of which American and Russian scientists are already pursuing, such as trying to understand the genetic secrets that make the virus so deadly. Combined with the intelligence assessment that other countries were harboring smallpox for military use, the academy report influenced the Clinton Administration's decision to forgo destruction of the virus.

The great unknown, experts say, is whether the benefits of such planning will ever be needed in a crisis and, if so, whether the protections will work as envisioned. But the consensus is that action is nonetheless needed.

Early this month, Federal experts meeting in Atlanta reviewed the germ threats facing the nation. Smallpox came out on top. Second was anthrax, which causes high fevers and death but is not contagious. In comparison, smallpox spreads like wildfire.

"It was unanimous that smallpox is the primary threat," said Dr. Henderson, who attended the Federal meeting. "The likelihood of an attack is small, but were it to occur it would be a real catastrophe." Copyright New York Times, 1999.

-- Alexi (Alexi@not_in_the_dark.com), June 15, 1999

Answers

This is more scary given the Korea situation...

-- Mad Monk (madmonk@hawaiian.net), June 15, 1999.

One of the news articles indicated that there was evidence that N. Korean soldiers were being vaccinated. Of course, they would be taking a big chance if they introduced the virus into South Korea, simce it would be fairly obvious where it came from.

Perhaps they would try to introduce it into the US. Then we may not know if it came from N. Korea, Iraq, Lybia, or Bin Laden, etc. They might also use it to blackmail the US.

-- Dave (dannco@hotmail.com), June 15, 1999.

There is an article on the smallpox threat on my website that I researched using the Univ. of Minn.'s biomedical library. Does anyone have good info about the efficacy of the vaccine wearing off years after exposure? The deadliness of the disease and the susceptibility of the vaccinated are widely known; this part is not.

my site: www.y2ksafeminnesota.com

-- MinnesotaSmith (y2ksafeminnesota@hotmail.com), June 15, 1999.

The scenario that bothers me more is this one.

After a local power outage of three weeks, the CDC's backup generators fail. Cultures of smallpox and other biohazard materials stored within the electrically-operated containment facilities may or may not get released into the local environment. Government officials pass the word "All is well.", but the neighbors are evacuated to special hospital camps "As a precaution." Six months later, refugees who admit they're from a three-state vicinity of the CDC facility are shot on sight by a panicked population afraid of being infected by a now rampaging plague.

Far-fetched? Maybe. Then again, maybe more likely than a smallpox attack from abroad. After all, these stockpiles are already within our borders. Is it possible? Like much of Y2K, we don't know. We can only hope.

What is disturbing is this: there have been no firm statements that in case of serious Y2K-induced failures that the cultures at the CDC and other facilities will be contained. There has been no discussion of contingency plans for emergency destruction (incineration?) of the cultures in the event that loss of containment appears imminent.

And more worrisome is that similarly, there is no such announced plan or procedure for any other biohazard stocks, be it biological agents at various labs or the Army's chemical weapons stored at various arsenals around the country. And in particular, the Army's stocks are known to contain deteriorating weapons that are being destroyed because of the threat accidental release.

As bad as Y2K may be, I'd hate to think that just as things are getting to some level of routine in months and years down the road, that some wierd cloud floating in from Tooele or Anniston would prove more disruptive and deadly than the possibilities of death by cold, thirst, starvation or disease in Y2K's predicted aftermath.

WW

-- Wildweasel (vtmldm@epix.net), June 15, 1999.